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Epistaxis

Overview
  • Definition: Bleeding from the nostril, nasal cavity, or nasopharynx.
  • Commonly referred to as a nosebleed.
  • Can be categorised into anterior and posterior bleeds.
Etiology
  • Anterior epistaxis (most common):
    • Originates from the Kiesselbach’s plexus on the anterior part of the nasal septum.
    • Common causes: dry air, nose picking, minor trauma, colds, allergies.
  • Posterior epistaxis:
    • Originates from branches of the sphenopalatine artery in the posterior part of the nasal cavity.
    • More likely in older adults.
    • Can be associated with hypertension, atherosclerosis, or trauma.
  • Other causes: coagulopathy, anticoagulants, antiplatelets, inherited bleeding disorders, neoplasms, inflammatory conditions, etc.
Clinical Features
  • Bleeding from one or both nostrils.
  • Possibility of swallowing blood, leading to haematemesis or melena.
  • Anxiety in the patient, especially if the bleeding is heavy or persistent.
Management
  • Stay calm and reassure the patient.
  • Have the patient sit up and lean slightly forward.
  • Pinch the soft parts of the nose together, just below the bony part.
  • For anterior bleeds, use of topical vasoconstrictors (e.g., oxymetazoline) or silver nitrate cauterisation if identified bleeding point.
  • For persistent or posterior bleeds: nasal packing, consider admission and/or otolaryngology (ENT) consultation.
  • Correct any coagulopathy or stop offending medications if safe and after discussing with relevant specialists.
Prevention
  • Saline nasal sprays or lubricants in dry climates.
  • Avoid nose picking.
  • Control hypertension.
  • Consider use of humidifier in dry environments.
Key Points
  • Most epistaxis episodes are self-limiting and from anterior sources.
  • Management involves pressure, topical treatments, and possibly packing.
  • Seek underlying causes, especially if recurrent or significant.

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